The present invention relates to a device for manipulating the uterus that delivers and removes gas from the patient's abdominal cavity during a laparoscopic surgical procedure. More specifically, the present invention relates to a device that efficiently transects the walls of the vagina while cycling gas through the cavity during a laparoscopic surgical procedure.
During a hysterectomy, a patient's uterus and cervix are surgically removed from the body. Utilization of the vaginal canal for abdominal access to reproductive organs is conventional in gynecologic surgery to minimize or eliminate the need to make incisions in the patient's skin. The use of laparoscopic or “minimally invasive” surgical procedures is becoming more common because of the reduced pain experienced by the patient, the reduced opportunity for infection, and faster recovery time as compared to the traditional open abdominal procedures.
In a laparoscopic hysterectomy, A camera and surgical tools are inserted through small incisions formed in the abdominal area to access the uterus within the abdominal cavity. The surgeon inserts a uterine manipulator through the vaginal canal to access the cervix. The surgeon may cut the vaginal tissue adjacent to the cervix using a laparoscopic cutting tool and a uterine manipulator, then remove the uterus and cervix through the vaginal canal.
Laparoscopic procedures routinely involve the insufflation of the abdominal cavity with pressurized gas in order for the camera to visualize the operative field. Gas such as carbon dioxide is used to distend the abdominal cavity. In procedures involving the cauterization of tissue, smoke created by the cauterization may hinder the surgeon's view of the operative field. Adequate visualization of the operative field requires cycling of the gas to remove the smoke. Two cannulas or lumens are inserted to simultaneously inject and remove gas to and from the abdominal cavity.
As minimally invasive surgery develops, there is also a trend in minimizing the size of the incision as well as the instrumentation. Small diameter cannulas placed through the abdominal wall incisions allow access and exchange of laparoscopic instruments. These cannulas also provide a means for gas exchange within the abdominal cavity. However, decreasing the diameters of the cannulas used to cycle gas while distending the abdominal cavity is limited by the requirement for adequate air flow, as the air flow rate is directly proportional to the cannula diameter.
A uterine manipulator is a surgical instrument that the surgeon uses to properly and effectively position the uterus within the pelvis and the abdominal cavity during medical procedures. A conventional uterine manipulator includes a balloon on a distal end of a shaft that is inserted into the uterus, such as the uterine manipulator device of U.S. Pat. No. 8,545,513, incorporated herein by reference. Grasping the handle on the proximal end of the shaft, the surgeon inserts a deflated balloon into the uterus, and then fills the balloon with water or other fluid. With the balloon expanded against the walls of the uterus, the surgeon can move and position the uterus by manipulating the shaft of the uterine manipulator. Movement of the uterus allows the surgeon to view anatomy around the uterus such as the posterior and anterior cul-de-sacs, the uterosacral and round ligaments, the fallopian tubes and ovaries, the cervix, and the bladder.
The uterine manipulator also includes a cervical engagement cup positioned on the shaft adjacent to the distal end. The cervical engagement cup aids in delineating anatomical structure as well as protecting vital structures such as the ureter and the uterine vessels. With the balloon positioned within the uterus, the cervical engagement cup receives the patient's cervix.
During a hysterectomy procedure, the surgeon inserts a cutting tool laparoscopically to cut along the rim of the cervical engagement cup. The small area to be cut at the junction of the cervix and the vaginal canal requires much precision in manipulation of the cutting tool. The surgeon controls the positioning of the cutting element of the cutting tool at the cervix-vaginal junction at a relatively large distance from outside of the body, either at the abdomen or the vagina. Manipulating the cutting element from outside of the body compounded by the high degree of precision required is difficult by even the most experienced surgeon's standards.
Further, light sources incorporated into surgical tools such as light delivery catheters and endoscopes are frequently introduced into the body to transilluminate anatomy. A transilluminating catheter delivers light to a distal portion of the body for performing phototherapeutic procedures as well as transillumination. Light emitting vaginal probes may be used to demarcate the vagina from the cervix. Various types of light emitting stents have been developed to transilluminate the ureters and uterine vessels from surrounding anatomy to prevent ureteral injury. However, such devices cannot transilluminate the upper vagina to identify the location of the ureters and its proximity to the uterine vessels while providing insufflation and smoke evacuation.
Consistent with the trend to minimize the size of laparoscopic incisions as well as the size and number of instrumentation, there is a need for a uterine manipulator device that provides multiple functionality during surgical procedures.